Effects of Visible and Invisible Parent Combat Injuries on Children

Family Caregiving August 01, 2013 Print Friendly and PDF

Authors: Adrian Blow, Ph.D.; Joel Ketner, M.S.; and Hiram Fitzgerald, Ph.D.

Michigan State University 


Service members returning from deployment may come home with a visible physical injury, such as loss of a limb; an invisible physical injury, such as traumatic brain injury (TBI); or an emotional injury, such as posttraumatic stress disorder (PTSD). Whatever the injury, adapting is one of the most difficult deployment-related challenges that service members and their families face. Unavoidably, these injuries affect children living in the home and may have a significant impact on their well-being, depending on a number of factors. Given that nearly half of active-duty service members have dependent children living at home, addressing the potential impact of parental injury on children and identifying potential ways of dealing with the related issues are crucial for the long-term health and well-being of military children.

Factors Affecting How a Child Interprets an Injury

Obviousness of the Injury

A service member's injury may be visible or invisible. Certain physical injuries include visual cues, such as bandages, loss of a limb, scarring, or a prosthesis. Other physical injuries and emotional injuries, such as TBI, PTSD, and depression, have no obvious physical symptoms. Still other difficulties, such as alcohol abuse, may or may not have physical symptoms. Invisible emotional injuries are widely prevalent, affecting up to 30% of service members returning from deployment. Regardless of its type, a service member's injury can have a profound effect on family life.

Physical injuries affect service members based on the type and severity of the injury. A service member who is physically unable to engage in the same activities he or she participated in prior to deployment may have to find new ways of relating to a child, and this transition might be confusing to the child. When a service member who has incurred moderate to severe physical wounds returns home, the relationship with his or her child is forever altered in some way because of injury-related limitations. For example, an injury may affect a parent’s ability to engage in or maintain daily parenting routines, such as picking up, feeding, or bathing a child. The child may feel rejected, confused, scared, angry, or sad, or may display a whole range of emotions related to this change.

Service members who incurred invisible physical or emotional wounds will not have the same obvious injuries as those with visible physical wounds. Symptoms related to invisible wounds include irritability, angry outbursts, rapid mood swings, heavy drinking, anxiety, sleeplessness, emotional numbing, memory loss, and a loss of interest in life activities. Children may experience the returned service member as someone very changed by the deployment. A once-vibrant parent may be withdrawn, may snap more than usual, and may appear despondent a lot of the time. These responses may be confusing to children and other family members. Children may find it easier to understand and, therefore, cope with visible injuries as compared to invisible wounds. For example, a child may feel empathy toward a parent who has a physical wound such as loss of a limb. The child might even feel pride about the sacrifice the parent made in war. On the other hand, a child might have difficulty attributing behaviors related to an emotional wound such as depression. The child may have questions such as, "Is he not happy to see me?" In addition, service members may be able to explain physical injuries to a child but may not have the language, motivation, or coherent explanations necessary to describe the complexities of an emotional wound. Moreover, invisible wounds may interfere with a service member's ability to express positive feelings to a child. A failure to communicate what is happening with a parent may lead to behavioral difficulties in a child because children often internalize (take personally) parent symptoms as they try to interpret a parent’s mood. For example, a child may internalize a parent’s anger over a behavior such as running in the house and likely will not ascribe the anger to symptoms associated with TBI. In this same way, observing symptoms such as avoidance or emotional numbing may lead a child to develop a sense of rejection by the injured parent and feelings of low self-worth.

Changes in the Home

Injuries invariably result in changes at home. Not only is the service member injured, but everyone at home is affected as well. For example, a spouse may need to engage in more caretaking behaviors, parents may argue more, the family may have fewer financial resources, and family members may feel much higher stress overall. These factors may inhibit optimal child development. In addition, a service member may need to spend a significant amount of time out of the house for rehabilitation and treatment of an injury. The need for additional surgeries and other medical issues might delay the return to “normal” after the injury. Demands related to caring for the injured service member may impair the other parent's ability to be attuned to the needs of a child, resulting in a negative impact on the child’s emotional, social, and physical development.

Age of the Child

Age is an important consideration in child development. An infant or toddler may have little recollection of how things were prior to a parent's deployment and may not perceive changes in the service member as significant. However, an older child might perceive changes in the service member from pre-deployment to post-deployment as drastic, and this perception might lead to a complete change in the relationship. Children may struggle to adapt to these changes and may act out with problematic behaviors as a result. Young children may be more demanding and more in need of their parents' attention, while adolescents might seek attention from peer networks and, as a result, potentially exhibit a different set of problematic behaviors.

Actions Parents/Caregivers Can Take to Help Minimize the Effects of an Injury on a Child

Open, Age-Appropriate Communication with Children

It is important that parents find ways to communicate with their children about what is happening with the service member and the family. Communication should be honest and age appropriate. Parents should provide reassurance to their children about the future. Also, parents should acknowledge how the children might be feeling (for example, scared, sad, angry) and help them understand that their experiences and feelings are normal under the circumstances. Parents need to work to communicate love and caring to their children, and if possible, find ways to spend one-on-one time engaging in connecting activities.

Creation of New Family Routines and Rituals

Children do well when there is predictability in the home environment. Deployment, even without a resulting injury, significantly interrupts family routines. When a service member is injured, family members may need to do even more to instill routines and rituals at home. Options include eating meals together, going on family outings, designating regular bed times, and engaging in activities such as reading together, telling stories, or playing family games. 

Use of a Support Network

The research literature is abundantly clear that support is a critical component of living with injury, for both the injured veteran and those in her or his relationship network. The more types of positive supports a family has, the better. These supports, which can include other caregivers, extended family members, and friends, can increase the number of positive, supportive attachment relationships in a child’s life.

Use of Professional Help

An increasing amount of help is available to service members and their families. Stigma related to invisible wounds is lower than ever before. Mental health providers are increasingly trained to apply sensitivity toward the unique culture of the military when working with service members and their families. Psychotherapists and marital, family, and child therapists all may be useful in helping children negotiate the difficulties related to deployment injury.


Gorman, L., Fitzgerald, H., and Blow, A. 2010. Parental Combat Injury and Early Child Development: A Conceptual Model for Differentiating Effects of Visible and Invisible Injuries. Psychiatric Quarterly (81): 1-21.


Adrian Blow, Ph.D.
Associate Professor and Program Director
Couple and Family Therapy Program
Department of Human Development and Family Studies
Michigan State University

Joel Ketner
PhD Student
Couple and Family Therapy Program
Department of Human Development and Family Studies
Michigan State University

Hiram Fitzgerald, PhD
Associate Provost for University Outreach and Engagement
University Distinguished Professor, Department of Psychology
Michigan State University


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This work is supported by the USDA National Institute of Food and Agriculture, New Technologies for Ag Extension project.